One of my cousins recently asked me to share with her girls group what HIV means in Mozambique and I thought it would be nice to share with all of you! Especially since I have not been writing in my blog every month like I wanted to.
Before I get into it, I would just like to say that everything here is from my point of view. As an American (an outsider in many ways), I often feel like I can never fully understand the impact of HIV on my friends and people in my community.
So first of all here are a couple facts about HIV and Mozambique:
ü 16.2% of the population (ages 15-49) is estimated to have HIV (Moz has a population of around 22 million people)
ü Young women ages 15- 24 have an estimated prevalence of 10.7% while young men in the same age group have an estimated prevalence of 3.6%
When I look at these statistics I kind of pass over the 16.2% population prevalence rate and get stuck on the fact that young women are so much more likely to contract HIV than young men. Everyone knows that the prevalence rate in Africa is really high, but for most countries in Sub Saharan Africa this rate is leveling off and even declining. Mozambique is the ONLY country where the rate is continuing to increase. Scary right? Especially when I start to think about the girls in my girls group and how much more likely it is for them to get HIV than it is for the boys in their class.
Why is it more likely for young women to get HIV? The most obvious reason is that our bodies are different. In most relationships in Mozambique, women are the “receivers.” Our bodies are designed to “catch” sperm and go on to produce as many babies as possible until our biological clock gives out.
Backing up a little. When a person has HIV, the virus lives in all bodily fluids: blood, tears, saliva, breast milk, etc…. The four fluids with the highest concentration in order from greatest to least are: blood, semen, vaginal fluids, and breast milk. All of the other fluids produced by our body contain HIV, but the quantity is so low that you would have to drink 5+ gallons of saliva in one sitting to get HIV (this is an estimate to show how unlikely it is for a person to get HIV by kissing, for example).
So when a man and woman are having sex, either one of them could contract HIV from the other. But, because of the way women’s bodies are designed and the higher concentration of HIV in sperm, it is more likely for a woman to contract HIV than a man. If either partner has a cut or sore (Sexually Transmitted Infection, STI), the chances of passing HIV to the other person increases dramatically (somewhere around 4 times more likely).
Moving on to the less obvious reason why young women are more likely to have HIV: social and cultural norms. In Mozambique, the estimate age of sexual debut (when someone has sex for the first time) is 12 for girls and 15 for boys. I was SHOCKED when I first heard that. At 12 years old, I was still wearing umbro shorts and no where near thinking about boys.
Here, it is normal for young girls to have relationships with boys their own age (not too surprising), but also with men much older than them. In the States, we have four different bases (everyone’s definition is different, but the idea is the same), but here in Mozambique there is really only one: home plate. This means that when a man approaches a young girl and says “Eu gosto de ti” (I like you), there is a good chance that a sexual relationship begins. Since there is not a culture of foreplay, most people just get straight down to business which leads to early pregnancy and the quick spread of HIV.
Why would young girls want anything to do with older men? To sum it up in one word: money. Don’t be too quick to judge. These girls are not prostitutes (which is a really mean word – sex worker is better). They are just like you and me. The only difference is we have more options available to us. In high school, if I wanted a pair of designer jeans, I picked up some extras shifts at the pharmacy where I worked. In Mozambique, these kinds of opportunities are rare and it is much easier to have your “namarado” or boyfriend pay for your nice clothes and hair.
From here stems the biggest problem. These men have relationships with young girls while at the same time have a wife at home and maybe another woman on the side. These young girls also want someone to be there for them and tend to also have a relationship with a young man around their same age. This is one of the main reasons why HIV has spread so much in Africa. In development terms: concurrency. This basically means that a person is having a sexual relationship with more than one person and each of those people is also probably having a relationship with one or more other people. You have probably heard the expression: when you sleep with someone, you are also sleeping with all of their previous partners. When you put it in terms of HIV and STIs, it’s true. It becomes this interconnected web of sexual relationships, where it is likely that a person is connected to several people at the same time even if only one of them is their actual partner. When you add HIV into the equation, it is not surprising the virus to able to spread so quickly.
So what about condoms? Condoms are the best way to protect yourself against HIV and other STIs (besides abstinence, which is the only 100% effective way). Luckily, condoms are sold almost everywhere here at a really low cost and are available free of cost at all health centers. Unfortunately, that is where the easy part ends. One thing that a lot of young women struggle with is getting their partners to agree to use condoms. Because of the unequal distribution of power between men and women, women often feel unable to stand up for themselves and condoms are forgotten. A lot of times women worry about losing their partner if they try to make any “demands” (like using a condom). There is also stigma that comes with suggesting condom use. If a woman asks to use a condom, her partner will inevitably ask her why. Is it because she doesn’t trust him to be faithful? Or because she is the one who is not being faithful? In my opinion, this is an extremely unfair question. The real issue here is not about who is sleeping with who, it is about protecting yourself and living the healthiest life possible.
One great thing that is beginning to show up more and more here in Mozambique is the female condom. It is the same idea as the male condom, but the female wears it. Another advantage is that some brands are not made out of latex and therefore it feels more like there is nothing between you and your partner. It can also be reused up to five times (again, depending on the brand). This is a good way for women here to take responsibility and provide and wear the protection. There is, however, another big challenge to overcome. A large majority of the population (especially the older generations) do not trust condoms (male and female) because they believe some condoms have HIV put in them to infect the African people. If they thought about the biology of HIV or if it had been explained clearly to them, they would realize that the virus can only survive in humans (hence the name: Human Immunodeficiency Virus).
“But wait?” They would ask, “what about mosquitoes? If malaria can be transferred from mosquitoes to humans, then why can’t HIV? They are both illness of the blood.” This is a question that ALWAYS comes up every time HIV is being discussed. The most important thing to remember is malaria is a parasite and HIV is a virus that needs a host (human) to survive. Therefore, the two cannot even be compared, but will always be lumped together because they are the most high profile illnesses in Moz.
“But what about needles and other sharp objects? HIV can survive on those right?” This question is a bit more complicated since Injection Drug Use (IDU) is, in some parts of the world, the main method of HIV transmission. In these cases the needle or other sharp object has gone straight from one persons arm to the next, injecting “live” blood (not dried) directly into another person. Most Mozambicans put a lot of emphasis on sharp objects transferring HIV instead of focusing on the fact that heterosexual relationships are the main method of transmission. It is easy to understand why they would choose to focus on sharp objects (like barber shears or needles used at the hospital) because it puts the blame on someone else. It is also hard to blame HIV transmission on sex since it is one thing that every person on the planet has in common (besides maybe priests) and you and I exist because someone somewhere had sex.
So now let’s move on to mother to child transmission. This is another area of HIV transmission that can lead to a little confusion. There are three ways in which a child can get HIV from its mother: during labor and delivery, breast feeding, and any time during pregnancy. The first two methods are widely known by most Mozambican women. If a woman takes the necessary precautions (taking anti-retrovirals (ARVs), etc…), there is less than a 2% chance that her child will get HIV during delivery. The issue of breastfeeding is a little more complicated, but basically the children can only eat/drink breast milk for the first 6 months (this amount of time varies) of life and the mother needs to continue taking ARVs to keep her viral count (amount of HIV in her body) low. The third and final method of transmission is any time during pregnancy. This is also the reason why people are fighting to change the acronym PMTCT (prevention of mother to child transmission) to PPTCT (parent instead of mother) because technically HIV would be transmitted from the father (or any of the mother’s sexual partners) to an HIV negative mother and to the baby. There is also the possibility of a HIV positive woman passing HIV to her baby if she has advanced HIV disease, which would increase the level of HIV in her bloodstream.
